心电门控非对比增强静息间隔单次激发MR血管成像在下肢动脉狭窄中的应用价值

Nonenhanced electrocardiogram-gated quiescent-interval single-shot MR angiography of the lower extremities: comparison with CT angiography

目的探讨心电门控非对比增强静息间隔单次激发MR血管成像(QISS MRA)在下肢动脉狭窄中的应用价值。方法回顾性分析2017年4月至12月华中科技大学同济医学院附属协和医院,有下肢缺血表现且同时进行了下肢动脉CTA及QISS MRA检查的30例患者。患者均成功进行了下肢动脉CTA及心电门控非对比增强QISS MRA检查。将整个下肢动脉分成19段(腹主动脉下段、髂总动脉、髂内动脉、髂外动脉、股浅动脉、股深动脉、腘动脉、胫前动脉、胫后动脉、腓动脉)进行评价,2名医师采用4分法对QISS MRA和CTA图像质量进行评分,并对动脉狭窄严重程度进行评估。同一患者不同检查方法狭窄程度及同一患者不同医师狭窄程度评分一致性的评价采用Kappa分析。结果30例患者共采集到570个血管段。医师1的560/570(98.2%)段和548/570(96.1%)段的图像质量被CTA和QISS-MRA评为优秀或良好(3、4级),医师2的561/570(98.4%)段和544/570(95.4%)段的图像质量分别被CTA和QISS-MRA评为优秀或良好。医师1对CTA与QISS MRA的图像质量评分分别为(3.87±0.38)、(3.70±0.53)分,医师2分别为(3.86±0.40)、(3.68±0.54)分。QISS-MRA上,570个节段中仅7个(1.2%,7/570)节段得到不能满足诊断图像质量的图像。2名医师分别采用CTA与QISS MRA对不同节段血管狭窄程度评价的一致性良好,医师1对不同节段血管狭窄程度评价CTA与QISS MRA间的Kappa值为0.714~0.939,医师2的Kappa值为0.603~0.939;2名医师间采用QISS MRA对不同节段血管狭窄程度评价的一致性良好,Kappa值为0.813~0.933。结论在下肢动脉栓塞诊断中,QISS-MRA具有较大价值。

Objective To evaluate the diagnose value of nonenhanced electrocardiogram (ECG)-gated quiescent-interval single-shot MR angiography (QISS MRA) in lower extremity arterial stenosis. MethodsA retrospective analysis of 30 patients with lower extremity ischemic manifestations and concurrent lower extremity arterial CTA and QISS MRA was performed from April to December 2017 at the Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. All patients underwent CTA and ECG-gated non-contrast-enhanced QISS MRA. The entire lower extremity arteries were divided into 19 segments (lower abdominal aorta, common iliac artery, internal iliac artery, external iliac artery, superficial femoral artery, deep femoral artery, radial artery, anterior tibialis anterior tibial artery, posterior tibial artery, radial artery). Two radiologists scored QISS MRA and CTA image quality using a 4-point scale and assessed the severity of arterial stenosis. Kappa analysis was used to evaluate the degree of stenosis of different examination methods in the same patient and the consistency of the scores of different radiologsts in the same patient. ResultA total of 570 vessel segments were collected from 30 patients. The image quality of 560/570 (98.2%) and 548/570 (96.1%) of radiologist 1 was rated as excellent or good by CTA and QISS-MRA (grades 3 and 4), and 561/570 (98.4% of radiologist 2) The image quality of the segment and the 544/570 (95.4%) segment were rated as excellent or good by CTA and QISS-MRA, respectively. The image quality scores of radiologist 1 to CTA and QISS MRA were (3.87±0.38) and (3.70±0.53), respectively, and radiologist 2 were (3.86±0.40) and (3.68±0.54) respectively. On the QISS-MRA, only 7 of the 570 segments (1.2%, 7/570) obtained images that could not satisfy the diagnostic image quality. The two radiologists used CTA and QISS MRA to evaluate the consistency of different degrees of vascular stenosis. The radiologist 1 evaluated the Kappa value of CTA and QISS MRA between 0.714 and 0.939 for different degrees of vascular stenosis. Radiologist 2 had a Kappa value of 0.603 to 0.939. QISS MRA was used to evaluate the consistency of vascular stenosis in different segments between the two radiologists. The Kappa value ranged from 0.813 to 0.933. ConclusionQISS-MRA is of great value in the diagnosis of lower extremity arterial stenosis.